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Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Item/Service Description

The durable medical equipment (DME) list that follows is designed to facilitate the Medicare Administratinve Contractor’s (MAC's) processing of DME claims. This section is designed as a quick reference tool for determining the coverage status of certain pieces of DME and especially for those items commonly referred to by both brand and generic names. The information contained herein is applicable (where appropriate) to all DME national coverage determinations (NCDs) discussed in the DME portion of this manual. The list is organized into two columns. The first column lists alphabetically various generic categories of equipment on which NCDs have been made by the Centers for Medicare & Medicaid Services (CMS); the second column notes the coverage status.

In the case of equipment categories that have been determined by CMS to be covered under the DME benefit, the list outlines the conditions of coverage that must be met if payment is to be allowed for the rental or purchase of the DME by a particular patient, or cross-refers to another section of the manual where the applicable coverage criteria are described in more detail. With respect to equipment categories that cannot be covered as DME, the list includes a brief explanation of why the equipment is not covered. This DME list will be updated periodically to reflect any additional NCDs that CMS may make with regard to other categories of equipment.

When the MAC receives a claim for an item of equipment which does not appear to fall logically into any of the generic categories listed, the MAC has the authority and responsibility for deciding whether those items are covered under the DME benefit.

These decisions must be made by each MAC based on the advice of its medical consultants, taking into account:

NOTE: The term “room confined” means that the patient’s condition is such that leaving the room is medically contraindicated. The accessibility of bathroom facilities generally would not be a factor in this determination. However, confinement of a patient to a home in a case where there are no toilet facilities in the home may be equated to room confinement. Moreover, payment may also be made if a patient’s medical condition confines him to a floor of the home and there is no bathroom located on that floor.

Communicators

(See §50.1 of this manual, Speech Generating Devices.)

Continuous Passive Motion Devices

Continuous passive motion devices are devices Covered for patients who have received a total knee replacement. To qualify for coverage, use of the device must commence within 2 days following surgery. In addition, coverage is limited to that portion of the 3-week period following surgery during which the device is used in the patient’s home. There is insufficient evidence to justify coverage of these devices for longer periods of time or for other applications.

Covered if MAC's medical staff determines patient’s condition is such that periodic movement is necessary to effect improvement or to arrest/retard deterioration condition.

Percussors>

Covered for mobilizing respiratory tract secretions in patients with chronic obstructive lung disease, chronic bronchitis, or emphysema, when patient or operator of powered percussor receives appropriate training by a physician or therapist, and no one competent to administer manual therapy is available.

Covered if patient meets Mobility Assistive Equipment clinical criteria (see §280.3 of the NCD Manual). Coverage is limited to those roll-about chairs having casters of at least 5 inches in diameter and specifically designed to meet the needs of ill, injured, or otherwise impaired individuals.

Coverage is denied for the wide range of chairs with smaller casters as are found in general use in homes, offices, and institutions for many purposes not related to the care/treatment of ill/injured persons. This type is not primarily medical in nature. (§1861(n) of the Act.)

Deny - not primarily medical in nature; personal comfort items (§§1861(n) and 1862(a)(6) of the Act).

Seat Lifts

Covered under the conditions specified in §280.4 of this manual. Refer all to medical staff for this determination.

Self Contained Pacemaker Monitors

Covered when prescribed by a physician for a patient with a cardiac pacemaker. (See §§20.8.1 and 280.2 of this manual.)

Sitz Baths

Covered if MAC's medical staff determines patient has an infection or injury of the perineal area and the item has been prescribed by the patient’s physician as a part of his planned regimen of treatment in the patient’s home.

Spare Tanks of Oxygen

Deny - convenience or precautionary supply.

Speech Teaching Machines

Deny - education equipment; not primarily medical in nature (§1861(n) of the Act).

Stairway Elevators

Deny - (See Elevators.) (§1861(n) of the Act).

Standing Tables

Deny - convenience item; not primarily medical in nature (§1861(n) of the Act).

Steam Packs

These packs are Covered under the same conditions as heating pads. (See Heating Pads.)

Suction Machines

Covered if MAC's medical staff determines that the machine specified in the claim is medically required and appropriate for home use without technical or professional supervision.

Deny - these are emergency communications systems and do not serve a diagnostic or therapeutic purpose.

Toilet Seats

Deny - not medical equipment (§1861(n) of the Act).

Traction Equipment

Covered if patient has orthopedic impairment requiring traction equipment that prevents ambulation during the period of use (Consider covering devices usable during ambulation; e.g., cervical traction collar, under the brace provision).

Trapeze Bars

Covered if patient is bed confined and the patient needs a trapeze bar to sit up because of respiratory condition, to change body position for other medical reasons, or to get in and out of bed.

Treadmill Exercisers

Deny - exercise equipment; not primarily medical in nature (§1861(n) of the Act).

Ultraviolet Cabinets

Covered for selected patients with generalized intractable psoriasis. Using appropriate consultation, the MAC should determine whether medical and other factors justify treatment at home rather than at alternative sites, e.g., outpatient department of a hospital.

Covered if patient is homebound and has a (standard)condition for which the whirlpool bath can be expected to provide substantial therapeutic benefit justifying its cost. Where patient is not homebound but has such a condition, payment is restricted to the cost of providing the services elsewhere; e.g., an outpatient department of a participating hospital, if that alternative is less costly. In all cases, refer claim to medical staff for a determination.

05/1989 - Added introduction to facilitate DME claims processing. Deleted references to manufacturers' brand and replaced with generic counterpart. Added statutory authorities for denial if authority other than 1862(a)(1). Added Blood Glucose Analyzer-Reflectance Colorimeter-deny as unsuitable for home use to list. Modified Communicator to specify that in addition to being a convenience item is not primarily medical in nature. Modified Heat and Massage Foam Cushion Pad-deny to specify as not primarily medical in nature; personal comfort item. Modified Injectors to specify that effectiveness not adequately demonstrated. Reorganized Iron Lung, Respirators and Ventilators to more accurately reflect current medical terminology but not affecting the coverage status. Effective date NA. (TN 36)

07/1990 - Covered air-fluidized beds. Effective date (TN 44)

02/1999 - Clarified non-coverage policy for hypodermic jet pressure powered devices for the injection of insulin because of statute rather than effectiveness of device. Effective date NA.(TN 107)